American College of Surgeons Supports Developing a National Trauma Action Plan

WASHINGTON, May 16, 2017  As Trauma Awareness Month progresses throughout May, the American College of Surgeons Committee on Trauma (ACS COT), today again voiced its strong support for implementing a National Trauma Action Plan to close the gaps in trauma care in the United States, reduce unnecessary deaths, encourage data sharing and increase trauma research funding. The plan also calls for integration of Military Treatment Facilities and providers into the civilian trauma system in order to keep military teams always prepared for deployment. This plan is vital to both homeland and national security.

Just last month, surgeons, physicians, nurses, and representatives from government, public health, emergency medical services and the military joined together to create such a plan. The conference, "Achieving Zero Preventable Deaths: Building a National Trauma Action Plan," was held April 18-19 at the National Institutes of Health (NIH) in Bethesda, Md.

The conference was sponsored by ACS COT, the National Highway Traffic Safety Administration (NHTSA), the U.S. Department of Defense (DOD), The National Academies of Science, Engineering and Medicine (NASEM) and NIH. The plan is being developed in response to a 2016 report by NASEM, "A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths," which found one of five trauma deaths could have been prevented if advances in trauma care reached all Americans.

"Traumatic injury ? such as car crashes, falls, head injuries, burns and firearm injuries ? continues to be the most important health problem of three vitally important groups: our children, adults up to age 47 and our deployed military service members during times of conflict," said Ronald M. Stewart, MD, FACS, Chair, ACS COT. "This is a health crisis we can no longer ignore. At least one-third of Americans live in an area without a complete trauma system, and tens of thousands of lives are lost unnecessarily each year." In addition, trauma costs the U.S. $671 billion per year in health care costs and lost productivity.

Federal Leadership Will Speed Advances in Trauma Care
Conference speakers acknowledged that many of the issues in the NASEM report were first identified in the 1966 National Research Council report, "Accidental Death and Disability: The Neglected Disease of Modern Society." Many speakers acknowledged that much progress has been achieved in the ensuing 50 years, but a new national trauma action plan is desperately needed. Failure to implement such a plan will result in needless loss of life and suffering from traumatic injury.

Speaking via video, Don Berwick, MD, MPP, former Administrator of the Centers for Medicare and Medicaid Services (CMS) and President Emeritus and Senior Fellow, Institute for Healthcare Improvement, said the federal government has previously taken insufficient ownership to close gaps in trauma care that have been driven by the private sector, including the ACS COT. "There was far more inaction than action. That must end today." Dr. Berwick chaired the NASEM report committee and has been actively involved in advancing its recommendations.

There was consensus among meeting participants that leadership should come from the federal government and be housed either within the Department of Health and Human Services (HHS) or, a new suggestion, the Department of Homeland Security (DHS). DHS was offered as a solution because trauma systems should be considered a part of national preparedness and security. The group will continue to work with trauma stakeholder organizations and federal officials and policymakers to identify the most appropriate home. Conference attendees also agreed that there should be flexibility for the states and regional systems to optimize implementation.

Other key points of discussion included:

• The need for a significant increase in research funding and a unified research agenda across the continuum of care, from pre-hospital to rehabilitation in order to continue to improve outcomes for trauma victims.
• Opportunities for military and civilian trauma systems to share innovations under one national trauma system, to ensure military trauma providers maintain skills and readiness, while sharing innovations between civilian and military systems. To that end, the recently signed National Defense Authorization requires that all major military treatment facilities participate in the U.S. trauma system and efforts are underway to support integration of military medical teams in civilian trauma centers to optimize training.
• The importance of engaging the public through programs such as Stop the Bleed, which turns bystanders of trauma events into immediate civilian responders before medical care arrives on the scene.
• And lastly, the critical need to engage and empower trauma survivors and their families as key advocates for advances in care.

Action Plan Will Address Gaps in Trauma Care
Due to the efforts of the entire trauma care community, the past 50 years have witnessed radical improvements in trauma care and injury prevention; however, there remain significant opportunities for improvement:

• The trauma system is not yet complete and gaps in care remain.
• Emergency medical service (EMS) care is highly variable from region to region.
• In many regions Levels I and II trauma centers aren't distributed based on population need.
• Perhaps the biggest gap remains the lack of adequate research funding targeted at improving outcomes for injured patients.

"Even though traumatic injury results in more loss of years of life and disability than any other disease, it receives significantly less research funding than HIV/AIDS, cancer, heart disease and other conditions, including relatively rare diseases like Ebola," said Eileen M. Bulger, MD, FACS, member of the executive committee of the ACS COT. "Today, we can't track a patient from their point of injury to the hospital and back home again. We need to ensure data is collected at every stage of trauma care and we need to conduct research that will allow us to save more lives, lessen post-injury morbidity and prevent injuries from occurring in the first place."

"Injury can occur at any time, to any person of any age," said Robert J. Winchell, MD, FACS, chair, ACS Trauma Systems Evaluation and Planning Committee. "A national trauma system is key to saving thousands of people a year who die unnecessarily from injury. It's also an important element of national and homeland security and a backbone for disaster preparedness in this country. As a nation, we must address this vital need."

In addition to developing the National Trauma Action Plan, the ACS COT is actively supporting federal policies that will advance trauma care and has created the Military Health System Strategic Partnership American College of Surgeons (MHSSPACS) to strengthen ties between civilian and military health systems. Congress is expected to vote on the Mission Zero Act (H.R. 880) sometime this year; the bill would provide $40 million in funding to the HHS to facilitate partnerships between military trauma care teams/providers, and high-volume civilian Level I trauma facilities.

"Through the MHSSPACS, we are already taking important steps to achieve the NASEM report's goals," said M. Margaret (Peggy) Knudson, MD, FACS, medical director of the MHSSPACS. "Our close ties with our partners in the military are allowing us to share trauma innovations, and expand education and training opportunities. Passing the Mission Zero Act will allow us to take these initiatives further by partnering civilian and military surgeons and care teams at some of the busiest trauma centers in the nation." 

About the ACS Committee on Trauma
ACS has focused on efforts to improve care for injured patients since it formed the COT in 1922 (then known as the Committee on Fractures). Today, the COT, which is administered by an 85-member leadership team and 3,500 regional surgeon leaders, oversees a spectrum of initiatives aimed at advancing the standard of trauma care for practitioners, trauma centers and trauma systems. These initiatives include Levels I-IV trauma center verification, the nation's only risk-adjusted outcomes-based trauma quality program, and trauma courses taken by more than 1 million medical professionals globally.

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

SOURCE American College of Surgeons